The Dentist’s Role in Obstructive Sleep Apnea

Team Approach

As a dental health practitioner, my responsibility to a patient goes beyond just taking care of their teeth and gums. It is more of an approach which takes into account an individual’s overall health.

We learnt in the blog “The Link between Gum Disease and Cardiovascular Disease“, posted on May 27th 2013, that if you have an abundance of plaque in your mouth then it is possible for the bacteria in the plaque to get into your system and set up deposits in the arteries that supply the heart I.e., there is a link between poor oral hygiene and cardiovascular disease.

So we not only stress that you floss and brush for the health of your teeth and gums, but for your overall health as well.

Look at it more as a holistic approach that we want you to live by… A balance that includes focusing on exercise, eating well, your mental health, coping strategies, etc.

This goes back to my very first blog “Dental Wellness“posted on July 22nd, 2011.
With all of this being said, it is not surprizing that the dentist plays a significant role in Obstructive Sleep Apnea (O.S.A).

The approach in dealing with O.S.A is a multidisciplinary one. The dentist works closely with a sleep specialist who has done a sleep study on the patient and has come up with a diagnosis. This involves the patient being seen for an overnight in-depth sleep study (called a Polysomnogragh), the end result being a thorough diagnosis I.e., is it snoring or is it mild, moderate or severe O.S.A ?

In addition, dentists may find themselves working with other specialties in the medical field:
1) Ear, Nose and Throat Specialists (E.N.T): Both adults and children may present with an abundance of soft tissue at the back of their throats which may be causing some blockage of their airway and contributing to their O.S.A. If this is the case, the E.N.T can perform surgery to remove the excess tissue and improve the quality of the patient’s airway.
2) Cardiovascular Specialists: There is a very strong correlation between the severity of O.S.A and cardiovascular disease, more specifically high blood pressure or hypertension. When an individual’s airway is obstructed and they are not breathing for periods of time, this activates their sympathetic nervous system and causes havoc in their bodies …this often leads to high blood pressure…we will look into this more in a future blog.
3) Kidney Specialists: The increased blood pressure can put a lot of stress on the kidneys and this can lead to problems with their functioning.
4) Psychiatrist: If a patient is not sleeping properly, they probably won’t feel very well. This can range from moodiness, to depression and even impotence.
5) General Practitioner (family doctor): The General Practitioner is on the front line of detecting any of the issues that get referred to the specialists described above.

The dentist needs to have some contact with the family doctor as they are the ones who will refer the patient to the specialist’s office for further investigation.
All of the disciplines come together and we treat the patient as a whole. So, as dentists, we take an active role in the patient’s total health and as mentioned previously, this not only involves their teeth and gums, but also their airways.

Dentists should be able to recognize certain symptoms in their patients which should lead them to a specialist for a sleep study…see blog “Sleep Apnea – Symptoms Revisited,” posted on December 1st, 2013.

Treating the Problem
The dentist’s role becomes more specific when treating the patients snoring and sleep apnea.

Depending on the severity of the apnea, the treatment may be and most often is C.P.A.P (c.p.a.p) is the gold standard and first line of treatment for moderate to severe sleep apnea);however, some patients cannot tolerate a c.p.a.p machine…..this is where the dentist plays a more active role in treatment. This is through Oral Appliance Therapy (O.A.T) with the use of mandibular advancing devices…please see the blog “Let’s look at the different ways to open the airway,” posted on July 29th, 2013.

In order to manage Obstructive Sleep Apnea, it is best when the different medical specialties and the dentist work together…This ‘Team Approach’ is often the answer in many other situations in life as well…Think ‘Team.’

Yours in good health,

Dr. F. Keshavarz Dentistry

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